This blog is totally independent, unpaid and has only three major objectives.
The first is to inform readers of news and happenings in the e-Health domain, both here in Australia and world-wide.
The second is to provide commentary on e-Health in Australia and to foster improvement where I can.
The third is to encourage discussion of the matters raised in the blog so hopefully readers can get a balanced view of what is really happening and what successes are being achieved.

Monday, August 27, 2012

Weekly Australian Health IT Links – 27th August, 2012.

Here are a few I have come across the last week or so.

Note: Each link is followed by a title and a few paragraphs.
For the full article click on the link above title of the article. Note also
that full access to some links may require site registration or subscription payment.

General Comment

There are some
interesting news items this week. What surprises me is, again, all the
different initiatives we are seeing outside the NEHRS / PCEHR program.

Clearly the
Government deciding to help defray the time costs for GPs with the NEHRS is big
as well - as is the Audit Reports on HealthSMART and Myki.

I especially liked
this quote from the MyKi report:

“THE former state
Labor government failed to properly investigate other smartcard ticket systems
around the world when preparing to introduce myki, leading to a costly
underestimation of the project's complexity, a state inquiry has heard.” Remind
you of something?

And on HealthSMART
this was a ripper:

“The proposal for Victoria's abandoned $500 million e-health system was
cavalier and more of a concept than a properly developed business case, a
senior bureaucrat says.”

Oh dear - it seems
the lessons are never learnt!

Lastly - Vale Neil
Armstrong. I remember the black and white pictures and more so the sense of awe
at what had been done - as well as sense that most things were possible. I
wonder have we lost our way a little since those heady days?

Dan
Harrison

A NEW service which
uses online chat to prevent suicides is providing support to people in distress
who are unwilling to use telephone counselling services.

Launching Lifeline's Online Crisis
Support Chat service yesterday, the Federal Minister for
Mental Health, Mark Butler, said the service would be of great benefit to men
and younger people, who were less likely to seek help in person or over the
phone, and people in areas where conventional services were not available. Four
in five Australians were using the internet to seek health information, he
said.

SYDNEY, Aust. -
August 23, 2012 - InterSystems Corporation, a global
leader in software for connected care, today announced that Mater Health
Services has used the InterSystems
HealthShare™ healthcare informatics platform to rapidly develop an eHealth
Record for expectant mothers.

By offering an
electronic alternative to the paper-based Pregnancy Health Record currently
issued by Queensland Health to public maternity hospitals, the new system is
already benefiting both patients and clinicians. In a recent example, when a
pregnant woman was rushed to Mater's Pregnancy Assessment and Observation Unit,
Mater staff were able to expedite her critical treatment by having immediate
access to the patient's obstetric record and latest test results due to her
private obstetrician electronically sharing the information through his
practice system.

Queensland’s
Mater Health Services has used a system from global healthcare systems
provider, InterSystems, to rapidly develop an eHealth record for expectant
mothers.

Mater's Chief
Information Officer, Mal Thatcher, said that by offering an electronic
alternative to the paper-based Pregnancy Health Record currently issued by
Queensland Health to public maternity hospitals, the new system was already
benefiting both patients and clinicians.

According to
Thatcher, in a recent example, when a pregnant woman was rushed to Mater's
Pregnancy Assessment and Observation Unit, Mater staffs were able to expedite
her critical treatment by having immediate access to the patient's obstetric
record and latest test results due to her private obstetrician electronically
sharing the information through his practice system.

Mark Metherell
is health correspondent

THE long-awaited
e-health scheme has locked in the support of doctors, but full operation of the
electronic record system is still months away.

The government has
won the agreement of big doctors' groups, including the Australian Medical
Association, to new arrangements that will allow doctors to claim as much as
$100 from Medicare for collating health records with their patients. But as
part of the agreement the government has also agreed to postpone the deadline
for doctors to meet e-health capability requirements until next May, after
originally proposing February.

A $5 million telehealth project aims to enhance delivery of
mental health care in South Australia. The project, announced today, is funded
by the Commonwealth and the South Australian government under the $20 million
digital regions initiative.

The mental health project includes more than 100 new
videoconferencing units to upgrade call and image quality for more than 80
sites around the state, the Department of Broadband, Communications and the
Digital Economy said. The project aims to reduce patient travel time, enable
online access to health services, connect patients with family members living
far away and “deliver rount the clock emergency triage and liaison services,”
the department said.

HCN
Launches Integration Framework for Medical Director

Health
Communication Network (HCN), the developers of market leading clinical
software, Medical Director, have today announced the launch of an Integration Framework
for Medical Director. The launch will take place at the Hyatt in Sydney
today.

The framework
manifests as the MD
Sidebar in Medical Director. Partner companies can now develop
Widgets (applications) which can be downloaded by Medical Director customers
from the Widget store. The MD Sidebar
will be launched to Medical Director customers in a November 2012 release.

Australia’s eHealth
strategy has created a real need in the market for robust, supportable
communication and information sharing mechanisms. The Integration
Interface launch today is about collaboration and creating a real opportunity
for clinicians and health care organisations to improve this information
sharing and through those mechanisms make a real difference in patient
care. On the other side of this is the time poor clinician who needs
tools and information at their fingertips, it needs to be fast, secure and reliable.

The AMA has
welcomed the government's announcement that doctors will be paid for
transferring patients to the PCEHR scheme.

Full details of the
new arrangements can be seen on the Medicare website here.

According to the
site:

The time spent by a
medical practitioner on the following activities may be counted towards the
total consultation time:·

Reviewing a
patient's clinical history, in the patient's file and/or the PCEHR, and
preparing or updating a Shared Health Summary where it involves the exercise of
clinical judgement about what aspects of the clinical history are relevant to
inform ongoing management of the patient's care by other providers; or

Preparing an Event
Summary for the episode of care.

Preparing or
updating a Shared Health Summary and preparing an Event Summary are clinically
relevant activities. When either of these activities are undertaken with
any form of patient history taking and/or the other clinically relevant
activities that can form part of a consultation, the item that can be billed is
the one with the time period that matches the total consultation time.

MBS rebates are not
available for creating or updating a Shared Health Summary as a stand alone
service.

GPs have finally
been given clear permission to bill Medicare for the time they spend organising
a patient’s e-health record, with new explanatory notes added to the MBS that
doctors’ groups have hailed as a breakthrough.

Health Minister
Tanya Plibersek originally announced GPs would be able to bill for the
preparation of shared health summaries on the new system, but the item number
billed had to be justified on the basis of the complexity of the consultation.

Last night,
speaking at the AMA’s annual parliamentary dinner in Canberra, the minister
announced e-health billing would now be time-based instead and that the
e-health PIP would be extended until May 2013.

A Victorian government-funded electronic health service will be offered
to people with chronic illnesses across Australia, following the announcement
that 10,000 patients had signed up for the service.

Victorian health minister David Davis announced that the Collaborative Care
Cluster Australia (CCCA) is now a national program that “empowers patients to
work collaboratively with their GPs, specialists, pharmacists and other
healthcare professionals to manage their own health issues using a new online
capability.”

Davis was referring to the CCCA’s Chronic Disease Management Network
(cdmNET), an online system that links patients with their own care plan and
helps an entire healthcare team share information.

Identifying humans,
especially patients, is stupefyingly hard. Even after too many years of
healthcare interoperability, I still can’t believe how hard it is. One of the
reasons it’s so hard to grasp is because as humans, we are intrinsically good
at identifying other humans. But it just doesn’t scale when it comes to
successfully identifying humans in distributed systems with more than a few
people who must perform the identification.

Many people look to
biometrics to solve this problem. The common candidates are finger prints,
retinal patterns, some form of phenotyping and most of all, genetic
sequences. But all these suffer from problems (and see particularly http://www.schneier.com/essay-019.html).
Given the expense and reliability problems associated with biometric markers,
most healthcare institutions rely on social identifiers. These typically are a
selection taken from the candidates listed in the following table, which
briefly discusses the issues associated with them.

THERE has been a
lot of discussion recently about the Personally Controlled Electronic Health
Record, particularly concerns about whether it is ready and who will manage it,
privacy risks and potential errors.

However, overall
there seems to be agreement that this is a step in the right direction.

It’s easy to get
swept up in the enthusiasm for new technology. But can we be confident that the
new is always better than the old? Is electronic always better than manual?

There are lessons
from the live information system experiment that has been ongoing in Australian
hospital emergency departments (EDs) since the early 1990s.

VICTORIA'S
abandoned multi-million-dollar e-health system implemented in just a handful of
hospitals was overly ambitious and has not improved patient safety, an inquiry
has been told.

The HealthSMART
rollout began in 2003, costed at $360 million, under the previous state Labor
government, but is fully operational at just four health services across
Victoria, including Melbourne's Royal Eye and Ear Hospital.

Hospital chief
executive Ann Clark said it would have been better to have different
information technology systems to suit individual hospitals but develop a set
of common rules so information could be shared.

Adam
Carey

THE former state
Labor government failed to properly investigate other smartcard ticket systems
around the world when preparing to introduce myki, leading to a costly
underestimation of the project's complexity, a state inquiry has heard.

The myki ticket
system was initially supposed to be running by March 2007, but more than five
years later it is still being introduced at a total cost of $1.52 billion -
more than half the cost of NASA's recent Mars mission.

Transport Ticketing
Authority chief executive Bernie Carolan said the authority and the former
government should have looked more closely at the problems other systems had
struck. ''There wasn't so much effort, with hindsight, in taking jurisdictional
soundings … either elsewhere in Australia or overseas to canvass the pitfalls
of implementing a new smartcard system,'' Mr Carolan told a hearing at State
Parliament.

Melbourne
researchers believe they may be on the brink of rewriting the history of the
universe.

A paper being
published in a US physics journal suggests it may be possible to view
"cracks" in the universe that would support the theory of quantum graphity -
considered to be the holy grail of physics.

The team of
researchers from the University of Melbourne and RMIT say that, instead of
thinking of the start of the universe as being a big bang, we should imagine it
as a cooling of water into ice.

In 'Australian Story' last night, we were reminded by Nicola Roxon & Kevin Rudd of how difficult was their task of bringing more integration to Federal-State roles in health. Maybe they began at the wrong place, maybe they were swamped by the "big picture", maybe there were elements at play of sheer bloody-mindedness. Whatever, it's instructive to read Atul Gawande's Big Med, his commentary in the LiveChat follow-up, then Cheesecake Factory Medicine in WSJ and then Joe Klein's The Wall Street Journal’s Cheesecake Fallacy.

@Earl, I don't believe any are at this point, but they will need to when the new privacy laws come in. I understand that they will become law as soon as next month when the Senate passes the legislation, then with a phase in period. I know a few vendors are looking at integrating security technology into their offering (we are talking to a couple now, but some of the big guys seem to have their heads in the sand.

Thanks, Paul. My last experience with the Prescriber Shopping desk at Medicare was for them to ask my university of qualification, not exactly a secret question. My GP complains that the local hospital will not release any information about his patients over the phone. Recently, during a walk, we both smelled gas. I called the company to report it and he asked for my name, street address & a contact number. Maybe he was looking up his database at the same time to check whether it may have been a crank call. I was half expecting him to ask for the registration number of a vehicle that I own. It could have been an impersonator, of course, since all that info is in public domain. I wonder how the new privacy regs will interfere with the free flow of patient details that are passed between practitioners during a telephone consultation. For example, when pathologist A phones surgeon B with results of a biopsy, will both be required to authenticate to each other?Trevor

A Victorian government-funded electronic health service will be offered to every Australian with a chronic illness ...... CDMnet patients with chronic illnesses can access their care plan with their pharmacist in the pharmacy using a simple barcode.

Can someone explain what the pharmacist will do with this?

Will the system be profitable? In other words who will pay how much to CDMnet developers?